MEDICARE: RENAISSANCE ADULT MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1720661499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE ADULT MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	1017 REISTERSTOWN RD
Second Line	:
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-4207
Country	:	US
Telephone Number	:	410-580-9301
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 REISTERSTOWN RD
Second Line	:
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-4207
Country	:	US
Telephone Number	:	410-580-9301
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JULIE RAKHAMIMOV
Credential	:
Telephone Number	:	443-838-0007

Provider Enumeration Date	:	04/30/2021
Last Update Date	:	04/30/2021

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